Some ED therapeutic strategies might even increase ED recidivism. 2 Purported therapies for the ED treatment of acute migraine are legion and of mixed efficacy. 1 While our understanding of the pathophysiology of migraine continues to evolve, it is hypothesized that the pain of migraine results from a cyclic propagation of neural dysfunction and vasospasm in the brain. Diagnosis is made clinically using tools such as the POUND (pulsatile, one-day duration, unilateral, nausea or vomiting, and disabling) mnemonic. Migraines are characterized by recurrent, unilateral, throbbing headache associated with photophobia and nausea. Migraine is a common presentation in the ED. What is the best treatment for her in the ED? After a careful history and physical examination you decide she has a migraine. She has had similar headaches once a term that keep her from her clinical duties for 1 or 2 days if untreated. Erica, a healthy 24-year-old medical student, presents to your emergency department (ED) during your evening shift with a severe headache that she has had for the past 6 hours.
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